Provider Demographics
NPI:1700407582
Name:CULLINS PSYCHOLOGICAL AND COUNSELING SERVICES
Entity Type:Organization
Organization Name:CULLINS PSYCHOLOGICAL AND COUNSELING SERVICES
Other - Org Name:JOANNA CULLINS PSYD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOANNA
Authorized Official - Middle Name:M
Authorized Official - Last Name:CULLINS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:503-894-2725
Mailing Address - Street 1:3300 MAIN ST UNIT 111
Mailing Address - Street 2:
Mailing Address - City:FOREST GROVE
Mailing Address - State:OR
Mailing Address - Zip Code:97116-3240
Mailing Address - Country:US
Mailing Address - Phone:503-894-2725
Mailing Address - Fax:360-326-2255
Practice Address - Street 1:4400 NE 77TH AVE STE 275
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98662-6857
Practice Address - Country:US
Practice Address - Phone:503-894-2725
Practice Address - Fax:360-326-2255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-02
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)